唾液胃蛋白酶检测对胃食管反流病的诊断价值  

The diagnostic value of salivary pepsin test in gastroesophageal reflux disease

作　　者：陈蓉蓉 冒慧 冯奔畅 王美峰[1] 林琳[1] 姜柳琴[1] Chen Rongrong;Mao Hui;Feng Benchang;Wang Meifeng;Lin Lin;Jiang Liuqin(Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院消化内科,南京210029

出　　处：《中华消化杂志》2023年第10期670-676,共7页Chinese Journal of Digestion

摘　　要：目的探究唾液胃蛋白酶检测(Peptest)在胃食管反流病(GERD)诊断中的应用价值。方法选择2022年4至10月于南京医科大学第一附属医院消化内科门诊有典型反流和(或)烧心症状1个月以上拟诊为GERD,且均完成24 h食管pH值联合阻抗监测(24 h MII-pH)和高分辨率食管测压的81例患者。收集患者插管当天午餐后、出现症状后和随机唾液样本并进行Peptest。所有患者完成上述检查后均服用标准剂量质子泵抑制剂(PPI)2周。以24 h MII-pH结果为诊断GERD的金标准,分析Peptest最佳时间点,以及Peptest联合PPI试验对GERD的诊断价值。进一步将24 h MII-pH阴性患者分为Peptest阳性组和阴性组,通过比较两组患者烧心症状评分、胃食管反流病自测量表(GERD-Q)评分、反流特征和食管动力情况,探究Peptest在24 h MII-pH阴性患者中是否有鉴别价值。统计学方法采用卡方检验和非参数检验。结果24 h MII-pH监测结果显示,81例患者中21例(25.9%)确诊GERD,60例为24 h MII-pH阴性。出现症状后是Peptest的最佳时间点,出现症状后Peptest诊断GERD的灵敏度为80.9%,特异度为50.0%,准确性为58.0%。出现症状后Peptest联合PPI试验诊断GERD的特异度和准确性均高于出现症状后Peptest单独诊断(75.0%比50.0%、74.1%比58.0%),差异均有统计学意义(χ^(2)=8.00、4.65,P=0.005、0.031)。在60例24 h MII-pH阴性患者中,出现症状后Peptest阳性和阴性组各30例,出现症状后Peptest阳性组患者的烧心症状评分和GERD-Q评分均高于出现症状后Peptest阴性组[3.0分(2.0分,3.0分)比1.0分(0.0分,2.3分)、12.0分(9.8分,13.0分)比9.0分(6.0分,11.0分)],酸反流清除时间长于出现症状后Peptest阴性组[57.0 s(22.3 s,88.0 s)比18.3 s(9.6 s,32.1 s)],食管下括约肌静息压、完整松弛压均低于出现症状后Peptest阴性组[10.40 mmHg(5.75 mmHg,18.95 mmHg)比21.45 mmHg(10.65 mmHg,31.70 mmHg)、3.90 mmHg(2.05 mmHg,5.35 mmHg)比4.90 mmHg(3.76 mmHg,8.25 mmHg);1 mmHg=0.13Objective To explore the clinical application value of salivary pepsin test(Peptest)in the diagnosis of gastroesophageal reflux disease(GERD).Methods From April to October 2022,at the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University,a total of 81 patients with typical reflux and(or)heartburn symptoms for more than 1 month,who were diagnosed with GERD and completed 24-hour esophageal pH impedance monitoring(24 h MII-pH)and high-resolution esophageal manometry were enrolled.Salivary samples were collected after lunch,at the onset of symptoms,and at random time point on the day of intubation,and all patients received standard dose of proton pump inhibitor(PPI)for 2 weeks.The 24 h MII-pH results were taken as the gold standard for diagnosing GERD.The optimal time point of Peptest and the diagnostic value of combination of Peptest and PPI test in GERD diagnosis were analyzed.The 24 h MII-pH negative patients were further divided into Peptest-positive group and Peptest-negative group.The heartbrun scores,gastroesophageal reflux disease questionnaire(GERD-Q),reflux characteristics,and esophageal motility between the 2 groups were compared and to investigate the differential diagnostic value of Peptest in 24 h MII-pH negative patients.Chi-square test and non-parametric test were used for statistical analysis.Results The results of 24 h MII-pH indicated that 21 patients(25.9%,21/81)were diagnosed GERD and 60 patients were negative for 24 h MII-pH.The onset of symptoms was the optimal time point for Peptest,with a sensitivity of 80.9%,a specificity of 50.0%,and an accuracy of 58.0%.The specificity and accuracy of Peptest at the onset of symptoms combined with PPI test in GERD diagnosis were higher than those of Peptest at the onset of symptoms alone(75.0%vs.50.0%,74.1%vs.58.0%),and the differences were statistically significant(χ^(2)=8.00 and 4.65,P=0.005 and 0.031).Among 60 cases of 24 h MII-pH negative patients,30 were positive for Peptest at the onset of symptoms and 30 were

关 键 词：胃食管反流 唾液胃蛋白酶 24 h食管pH阻抗监测 质子泵抑制剂试验 

分 类 号：R57[医药卫生—消化系统]